I Remember Marjorie
Authors: Martin R. Liebowitz
Journal: Annals of Internal Medicine (2022)

On Being a DoctorSeptember 2022I Remember MarjorieFREEMartin R. Liebowitz, MDMartin R. Liebowitz, MDRenaissance School of Medicine at Stony Brook University, Stony Brook, New YorkSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-1569 Audio Reading - “I Remember Marjorie” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “I Remember Marjorie” by Martin R. Liebowitz, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In early February 1965, Marjorie—a beautiful 19-year-old unmarried Jamaican woman who had been pregnant for 6 weeks—came to the emergency department of Bronx Municipal Hospital Center with her frightened boyfriend 3 days after an illegal abortion. She had fever and abdominal pain. Examination suggested peritonitis, and her blood culture grew E coli. She was in acute renal failure. An emergency laparotomy confirmed peritonitis and revealed a perforation of the uterus. A hysterectomy was performed, and hemodialysis was started. Her sepsis gradually responded to intravenous antibiotics.Over the next 4 weeks, urine flow gradually increased; however, renal function did not return to normal as had been hoped. Instead, it remained at 15%. Marjorie began to feel well, dialysis was discontinued, and she was discharged to clinic follow-up. She had been in the hospital 3.5 months. Her renal diagnosis was presumed to be acute cortical necrosis, a known sequela of septic abortion with an uncertain long-term prognosis.During the following 6 months, Marjorie was followed closely in the renal clinic of Bronx Municipal Hospital Center and continued to feel well despite her barely adequate renal function. She very much wanted to be with her family in Jamaica. Her doctors were concerned and cautioned her about the need for close medical attention and effective blood pressure control. She was given a medical summary and everyone's best wishes to take with her. Her courage and sunny disposition had made her a favorite patient.We did not hear from Marjorie during the next 18 months until she reappeared at the hospital in April 1967, acutely ill. Her blood pressure had not been controlled in Jamaica for at least a year, and she had developed symptoms of uremia. She had lost all of her remaining renal function.After she was hospitalized, her blood pressure was controlled and she was started on a course of weekly 2-day peritoneal dialysis. The hospital was not yet capable of administering chronic hemodialysis. Initially, the peritoneal dialysis controlled her symptoms. Kidney transplantation was still in its earliest days and not readily available. She was evaluated at a center in New York but was not found to be a suitable candidate for a transplant.Weekly peritoneal dialysis had to be discontinued at the end of November because of increasing technical difficulties. Intermittent hemodialysis was resumed. However, gastrointestinal bleeding, sepsis, and seizures marked a downhill course.Marjorie died on December 13, 1967.Elective abortion became legal in New York State in 1970, three years before Roe v. Wade.I often think about Marjorie and write this with great sadness, because I had hoped that this generation of physicians would not have to confront such avoidable tragedies. Comments0 CommentsSign In to Submit A Comment Donald E Williams, M.D., FACP, FACEnone13 June 2022 A common thread Your tale of tragedy takes me back to 1965, San Francisco General Hospital. I was a third year medical student at UCSF, rotating through Internal Medicine at the County Hospital. A young, beautiful black lady was on peritoneal dialysis following a botched attempt at self-induced abortion. The dialysis procedure then was crude. I remember watching, a student just beginning to dip my feet into clinical medicine, and feeling a sense of horror as the attending said the outlook was grim. The young lady died shortly thereafter. I was struck then by the tragedy of it all. The tragedy has not lessened, and the image is still seared in my memory, 57 years later. Will we ever learn? Fred Farris MDnone14 June 2022 Abortion These are indeed tragedies. I have been a primary care physician for 36 years. Trained to do all that I can to preserve life. I believe the 600,000 babies that were aborted last year in this country were human beings also. Who will speak for them. How can a physician walk into one exam room and schedule an abortion and then into the next one and smile at the pictures on the phone of a new mother. Something is wrong with this. Even if you do not believe in a creator God and His plan for all people you know that abortion is wrong and it is hurting women as well. Not all physicians are for abortion. Let's spend some resources on helping these vulnerable women and the babies live and enjoy life even if it is difficult and inconvenient it is better than death. I am writing this not to convince you to change your political views but for you to have some compassion for the unborn and that childbirth is not a burden for women but a blessing and that by design women are much better in this role than men. Susan Lee, MD FACPRSOM SUNY Stony Brook28 June 2022 Timely I was blown away by this essay. The last sentence is the most telling and really hit home for me. Making abortion illegal will not make it go away. We are going back to the dark days of unsafe reproductive healthcare, literally going backwards. Dystopian times. Toni BrayerInternal Medicine19 September 2022 I care Dr. Ferris: I care about the over 400,000 children in foster care in the US. I care about the millions of young men and women who will have their dreams and economic futures thwarted by forced early parenthood. I care about the women who are injured physically and psychologically by having their personal rights taken away. I care about parents who are made to carry non viable infants to term. I care about the medical complications and injury that will occur as women seek other means. I care more about this than a collection of cells that cannot live independently. Author, Article, and Disclosure InformationAuthors: Martin R. Liebowitz, MDAffiliations: Renaissance School of Medicine at Stony Brook University, Stony Brook, New YorkCorresponding Author: Martin R. Liebowitz, MD; e-mail, martin.[email protected]edu.This article was published at Annals.org on 14 June 2022. PreviousarticleNextarticle Advertisement Audio Reading - “I Remember Marjorie” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “I Remember Marjorie” by Martin R. Liebowitz, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics September 2022Volume 175, Issue 9Page: 1337 ePublished: 14 June 2022 Issue Published: September 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...